title: Contextual determinants of maternal health care service utilization in Nigeria.
abstract: Despite the high maternal mortality ratio in Nigeria, the use of maternal health care services is very poor. Attempts to explain this situation has focused on individual level factors and the influence of community contextual factors have not received much attention. This study examined the relation of community factors to the use of antenatal care in Nigeria, and explored whether community factors moderated the association between individual characteristics and antenatal care visits. Data were drawn from the 2008 Nigeria Demographic and Health Survey among 16,005 women aged 15-49 years who had had their last delivery in the five years preceding the survey. Results from multi-level models indicated that living in communities with a high proportion of women who delivered in a health facility was associated with four or more antenatal care visits. Residence in high-poverty communities decreased the likelihood of antenatal care attendance. Living in communities with a high proportion of educated women was not significantly related to antenatal care visits. Community factors acted as moderators of the association between educational attainment and antenatal care attendance. Improvement in antenatal care utilization may therefore be enhanced by targeting poverty reduction programs and increasing health facility delivery in disadvantaged communities.
authors.affiliation: a Department of Sociology and Anthropology, University of Uyo, Uyo, Nigeria, and Demography and Population Studies Programme , University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Dorothy Ngozi
authors.initials: DN
authors.lastname: Ononokpono
authors.forename: Clifford Obby
authors.initials: CO
authors.lastname: Odimegwu
authors.forename: Eunice
authors.initials: E
authors.lastname: Imasiku
authors.forename: Sunday
authors.initials: S
authors.lastname: Adedini
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008429:Maternal Welfare; D008875:Middle Aged; D009549:Nigeria; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D026684:Personal Autonomy; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult